Alcohol Withdrawal Timeline

Most of the adult population in the United States (age 18 and older) has taken a drink of alcohol in their lifetime, around 86.8 percent as of 2013, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Over half (56.4 percent) of the population reported drinking in the month prior to the 2013 survey.

Alcohol is fairly cheap, legal for those aged 21 and older, and part of many social situations. Alcohol consumption may even have some health benefits when ingested in moderation. But that is the key: moderation. When someone drinks more than the recommended amount in a sitting, called binge drinking, and continues to do so regularly, a problem with alcohol may exist.

Binge drinking is defined by NIAAA as raising the blood alcohol concentration, or BAC, to levels above 0.08 g/dL, which usually means four or more drinks for a woman or five or more for a man in a two-hour timespan. Heavy drinking is binge drinking for five or more days out of a month. Engaging in patterns of heavy drinking may lead to the development of an alcohol use disorder (AUD), which NIAAA estimates about 16.6 million adults in America (18 and older) suffered from in 2013.

When drinking is perpetuated regularly, the changes in the brain’s chemical makeup may become more ingrained, and a dependency may be formed. Alcohol addiction occurs when both a physical dependence and a psychological dependence are present, and the individual may no longer be able to control the amount and frequency of drinking. The more a person drinks, the higher the person’s tolerance to alcohol becomes, and increased levels of alcohol may be required to produce the same effects.

One of the many side effects of addiction is withdrawal. When the brain becomes used to the presence and interference of alcohol, it may not work the same way it did before. When alcohol is removed, alcohol withdrawal syndrome may begin 6-48 hours after the last drink, NIAAA publishes. Alcohol withdrawal can be potentially life-threatening if not treated properly. Someone dependent on alcohol should not attempt to stop drinking without professional help.

Side Effects of Alcohol Withdrawal

In addition to the disruption of the “happy cells” in the brain, alcohol also increases the production of gamma-aminobutyric acid, or GABA, which acts as a natural tranquilizer and calms down some of the nerve firings. When alcohol is suddenly removed after a chemical dependency is created, a type of rebound may occur, causing the nerves to be overactive and creating some of the opposite effects of the calming and sedating properties of alcohol.

The New England Journal of Medicine (NEJM) reports that half of the individuals suffering from an alcohol use disorder will experience withdrawal symptoms that range from mild to severe, with 3-5 percent presenting with the most dangerous form of alcohol withdrawal called delirium tremens, or DTs. Seizures, severe confusion, fever, agitation, and hallucinations may be signs of DTs. Without treatment, delirium tremens may be fatal. For this reason, alcohol consumption should never be stopped “cold turkey” or without the support of a professional.

Other symptoms of alcohol withdrawal may not be as severe as DTs but may be intense and uncomfortable. These symptoms may include both physical and emotional side effects, such as:

Anxiety

Depression

Insomnia

Headache

Nausea

Vomiting

Abdominal cramps

Diarrhea

Trouble concentrating

Fatigue

Clammy skin

Muscle aches

“Foggy” brain

Tremors

Dilated pupils

Sweats

Rapid heart rate

Hypertension

Irritability

Cravings

Alcohol withdrawal is likely to peak around 72 hours after the last drink and taper off after 5-7 alcohol-free days, NEJM publishes. How dependent on alcohol a person is may influence the level of severity of the withdrawal symptoms. Dependence may be more severe in someone who drinks more alcohol more often and has done so for a long period of time, for example.

Family history of alcoholism and genetic predispositions may be involved in dependency levels, as may environmental factors like support systems or being the victim of traumatic events. Medical and mental health conditions may increase dependence and the risk for addiction.

In addition, the age at which someone began drinking can influence abuse rates. The National Survey on Drug Use and Health (NSDUH) of 2013 found that youths who drank alcohol before the age of 14 were almost five times more likely to have a problem with drinking or alcohol dependence later in life than their peers who were 18 or older before taking their first drink. Parts of the brain related to impulse control and decision-making may be damaged by alcohol, and these regions are still forming in young brains. As a result, the consequences of early drinking may last a lifetime.

Benefits of Medications and Medical Detox

Because of the potential dangers of stopping alcohol consumption suddenly when the brain and body are dependent on it, most professionals agree that medical detox is the safest route to abstinence. During medical detox, a person’s vital signs, like heart rate, blood pressure, body temperature, and respiration levels, can be monitored to ensure that they stay within normal levels. Medical professionals are on hand and readily available around the clock.

Medications are often used to help remove the alcohol safely from the bloodstream while keeping withdrawal symptoms from intensifying. Detox from alcohol, depending on the severity of the addiction, may last 5-7 days until withdrawal symptoms have largely been mitigated safely.

Some of the pharmaceutical methods used during alcohol detox may include:

Alcohol itself: Alcohol may be tapered off slowly to reduce the amount ingested over a slow and controlled time period in order to avoid DTs.

Benzodiazepines: Also central nervous system depressants, benzos like Valium (diazepam) and Librium (chlordiazepoxide) may help to continue to inhibit GABA production to keep withdrawal side effects at bay, Psychology Today

Topiramate (Topamax): Initially manufactured as a drug for treating epilepsy, topiramate may also be effective in managing withdrawal symptoms during alcohol detox. It may also reduce future cravings for alcohol by acting on GABA production and function in the brain, the journal Current Pharmaceutical Design

Antidepressants and anti-anxiety medications: Depression and anxiety may be side effects of alcohol withdrawal and can be managed with these medications.

Vitamin supplements: Alcohol can deplete natural nutrients in the body, so vitamins and minerals may be reintroduced via supplements.

Alcohol may also dehydrate the body, so drinking plenty of water during detox is important. A balanced nutrition plan, rich in protein and complex carbohydrates and low in refined sugar and processed foods, may help the brain and body heal more quickly and efficiently.

After the initial detox period, several other medications may be effective in maintaining abstinence and preventing relapse, such as:

Acamprosate (Campral): FDA-approved to treat alcohol addiction, according to the journal American Family Physician, this medication is usually started after a few days of detox once abstinence has been established. It may act on GABA production to inhibit future alcohol cravings and protracted withdrawal symptoms.

Naltrexone (ReVia and Vivitrol): Administered after alcohol is completely out of the body, this medication acts as an antagonist drug, blocking receptor sites in the brain and creating negative side effects if alcohol is reintroduced. This makes it an aversion-type medication.

Disulfiram (Antabuse): Started after alcohol has been fully removed from the system, this medication is another aversion medication that produces a negative reaction if alcohol is reintroduced, making it an effective tool for preventing relapse.

Baclofen (Lioresal): This medication is a muscle relaxant that The New York Times reports may be useful in helping to maintain alcohol abstinence.

Medications used during alcohol detox and addiction treatment can help to reduce cravings and mute withdrawal symptoms, potentially making it easier to remain alcohol-free. Some medications may help safely remove alcohol from the system, others target specific symptoms, and still others work to prevent relapse.

Medical detox is the optimal way to stop drinking, safely remove alcohol from the brain and body, and minimize withdrawal symptoms, helping to prevent relapse. Medical detox is usually part of a more comprehensive alcohol addiction treatment program that also will include behavioral therapy.

"At first I was hesitant about treatment, but as my stay continued on I ended up getting a lot out of groups and one on one sessions with my counselors. Definitely one of the best treatments I've ever been to.”- Charlie, San Diego Treatment Alum

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